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WHAT HAPPENS? To understand a little more about this condition, we need to revisit some cardiovascular system anatomy. We all remember that arteries carry blood away from the heart, and veins carry blood toward the heart. We might also remember that the aorta is the biggest artery in the systemic circuit, and it divides and subdivides again and again into smaller arteries. Tiny arteries are called arterioles, and most arterioles then turn into capillaries with walls made of delicate endothelium—just a single cell thick. This is where the oxygen/carbon dioxide exchange happens, along with nutrient/ waste exchange, by way of interstitial fluid. Capillaries then get bigger and slightly more complex in construction and become venules; venules converge into veins, and all the veins eventually feed back into the largest vein, the vena cava. In some areas, however, the arterioles and venules do not telescope down into capillaries; instead, they connect directly to each other. These sites are called arterio- venous anastomoses. They influence nearby circulation, and they are vulnerable to the extreme reactions to cold and/or stress that we see with Raynaud's syndrome. "My cardiologist said he believes—and it's rare apparently—that my heart attack was caused by Raynaud's: it affects the same kinds of arterioles that were involved in my heart attack." —Choice Kitchen, massage therapist and person with scleroderma and secondary Raynaud's phenomenon. C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 41 TWO KINDS OF RAYNAUD'S SYNDROME The first person to document this condition (and get the credit for it) was a French medical student named Maurice Raynaud in 1862. He proposed, and it was widely accepted, that this disorder is caused by extreme vasospasm in reaction to exposure to cold or stress. Since then, we have found that this condition occurs in two ways: as a freestanding disorder or as a complication of some other problem or situation. Raynaud's Disease: A Freestanding Condition The most common form of Raynaud's is also the less extreme, with the lowest risk of serious complications or tissue damage. This is Raynaud's disease. It develops independently of other conditions. Raynaud's disease is idiopathic: of unknown origin. It is a functional problem with vasoconstriction, but it doesn't lead to any structural changes in capillaries, and this is an important feature that helps to distinguish it from the other form of Raynaud's. Raynaud's Phenomenon: Caused by Something Else Raynaud's phenomenon occurs as a complication of some underlying disease or condition that impacts vasodilation and constriction. Contributing factors include autoimmune diseases, chemical exposures, mechanical issues, or other factors. Autoimmune diseases. There are several autoimmune diseases that can contribute to Raynaud's phenomenon. Scleroderma often has this component. (For more on the relationship between Raynaud's phenomenon and scleroderma, read "Crest Syndrome" in the November/December 2009 issue of Massage & Bodywork, page 106.) Other autoimmune diseases associated with the development of Raynaud's phenomenon include lupus, rheumatoid arthritis, and Sjögren's Syndrome. Chemical exposure. Nicotine is a powerful vasoconstrictor, and people who smoke are more prone to serious attacks of Raynaud's phenomenon than nonsmokers. Vinyl chloride, a chemical used in the plastics industry, is associated with this risk, as are several medications that change blood vessel function, including ergotamine (used for migraines), beta-blockers (used for hypertension), some cancer treatments, some over-the-counter cold and allergy medications, and birth control pills. Mechanical factors. The blood vessels in the extremities may be healthy, but if a person has other environmental factors or exposures that interfere in their function, they may lose the ability to respond appropriately to changes in ambient temperature. Using heavy or vibrating equipment (jackhammers, drills, belt sanders), doing repetitive tasks with the hands, If a person has ever had frostbite or surgery to the hands or feet, the risk of Raynaud's goes up.